Among those diagnosed with depression, there are those who suffer from a type that is difficult to treat: resistant depression. There, the patient usually performs two different types of treatment correctly and does not improve.
Physiotherapist Cláudio Andrade de Oliveira, 46, for example, was diagnosed during the pandemic. He was already taking two medications in the morning and one in the afternoon. But when covid-19 spread around the world, his condition worsened and the doctor diagnosed him.
Claudio has had mental disorders since adolescence. At the age of 18 he was already taking anxiolytics and when he lived in the United States in 2004 he also had severe depression, at which point he could not afford private treatment.
In 2009, he returned to Brazil and returned to treatment, but his mental health deteriorated during the pandemic: he lay down and could no longer work. “The psychiatrist increased the medication as much as possible and sometimes changed it, but nothing was fixed, I continued with extreme depression,” she reported.
Things started to improve in January of this year, after trying a ketamine treatment, which is having an impact. “Until now I no longer felt that extreme anxiety and anxiety, I feel the daily worries that everyone has,” he says.
He is currently undergoing specialist treatment, but has been released from treatment at the beginning of the year. “I was discharged today after six ketamine infusions,” he says.
What is ketamine?
cetamine In many countries, including Brazil, it is a hospital anesthetic used for sedation purposes, but it is also a new alternative to the treatment of resistant depression. In Brazil, it was approved in November 2020 by Anvisa (the National Agency for Health Care) as a cure for this type of mental disorder.
To do this, according to the Agency, it should be administered only in a hospital or a specialized clinic and in front of a health professional. It is used as an intravenous or nasal spray, but is not yet available in SUS.
Despite the results of the tests performedetamine Alexander Moreira de Almeida, an associate professor and psychiatrist at the UFJF (Faculty of Medicine at the Federal University of Juiz de Fora), is an associate professor and coordinator of Alexander Moreira de Almeida. PTA (Anxiety Disorder Program) from the same organization.
“It is a drug that has recently been launched and seems to have a faster effect, but its effectiveness and safety in its long-term use are not yet known,” Almeida said. “There has been a strong publicity campaign to promote this drug, but care must be taken,” he says.
When administered, the substance enters the brain, initiates a process of neuronal restoration, and leaves the body in about 20 hours. In this way, the cells begin to “talk” to each other better, with a better connection. With this, the areas affected by the disease work better again and patients notice that they are improving their symptoms of depression.
However, there are side effects. “The harmful effects of ketamine occur on infusion and can be potentially serious and even fatal, so an anesthesiologist needs to be accompanied by the procedure and in a hospital with full monitoring – a heart rate monitor, oximeter and blood pressure measured every 10 minutes.” says Tiago Gil, an anesthesiologist, founder of the organization ketamineactive member ASKP3, American society of ketamine doctors, psychotherapists & practitionersand a volunteer researcher IPq-HCFMUSP (Institute of Psychiatry, Hospital das Clínicas, Faculty of Medicine, University of São Paulo).
These are some of the most common side effects:
- Rising blood pressure;
- Increased heart rate;
- General anesthesia with shortness of breath;
- Nausea and vomiting;
- Dissociation (altered perceptual state of the surrounding world).
According to the anesthesiologist, all symptoms disappear within 24 hours of the infusion.
Dr. Amanda Rock *The 37-year-old, who also suffers from resistant depression, had a good response to the treatment of the substance. “It’s a milestone in my life because I’ve improved and I have almost no side effects, just dissociation, nausea and dizziness, but they go away quickly,” she says.
He was diagnosed about 20 years ago and was initially in a mild condition, so he was treated with an antidepressant. He responded to treatment for two years, but then stopped working.
Medications were adjusted and others were added, but the disease increased. Amanda also had electroconvulsive therapy sessions, but she never improved significantly. “I’ve never been able to get the medicine out,” he says.
However, in 2020, he also found ketamine, and this time, he got good results. “I did six sessions with the application of the line, but because it is a relatively new medicine, health professionals do not have much knowledge and are afraid to refer the patient to this type of treatment, ”says Rocha.
He says it’s much better today, though Continue conducting sessions from time to time.
Are there any other treatments for depression that are resistant to depression?
After treating resistant depression with two different classes of antidepressants, at the appropriate dose and duration of treatment, it is presented by a patient. it does not improve of the disease.
“The likelihood of responding to the third medication used is greatly reduced. It was evident in a study in the UK that the quality of the responses to the first, second, third and fourth antidepressants was assessed. dose“says Tiago Gil.
Psychiatrist Raissa de Alexandria, HULW-UFPB (Lauro Wanderley University Hospital of the Federal University of Paraíba), linked to the Ebserh Network, explained that resistant depression is one of the most serious conditions of the disease. “These are slow conditions that become chronic and can lead to more severe symptoms, such as suicidal ideation. But this can also happen in non-refractory conditions,” he said.
According to the expert, between 10% and 15% of patients with depression end up with treatment-resistant depression.
For resistant depression, in addition to the usual drugs associated with therapy, it is possible to treat the disease with transcranial magnetic stimulation, which is also used to treat many other psychiatric pathologies.
Electroconvulsive therapy is another possibility of pathology and, according to experts, is a very important tool that can save lives.
Psychotherapy is also important. “There are studies that show that if the patient undergoes cognitive-behavioral psychotherapy, in addition to the use of antidepressants, it can improve,” says Alexander Moreira de Almeida.
There are other medications, in addition to antidepressants, that together can improve treatment.
Regardless of the treatment, the patient must follow the instructions. “It is essential that patients have proper adherence to treatment. They often forget to take medication for a few days, do not take it regularly, or use other substances such as alcohol or drugs that may affect the functioning of the medication.” Alexandria warns …
It’s hard to talk about a cure for mental disorders. In these cases, when the treatment reaches its goal, the individual returns to a normal life, as before suffering from the disease. But that doesn’t mean it can’t be repeated at some point.
This is why it is important that even after the discontinuation of a doctor-guided medication, the patient is able to engage in physical activity, have a social relationship, and have a hobby that makes them feel good.
* At the request of the characters, the name has been changed